Our Latest Perspectives Posts

Avoiding MRSA at the Gym
Written by Ralph Morris, MD, MPH and Bruce K. Bernard, PhD

A healthy workout in the gym should leave you with a feeling of well-being and nothing worse than a duffle bag full of sweaty clothes.  It should not leave you with a MRSA skin infection.

What is MRSA?

MRSA, or “Methicillin-resistant Staphylococcus aureus,” is a type of staph bacteria that is, according to the US Centers for Disease Control and Prevention (CDC), resistant to common antibiotics.  CDC   reports that about two in every 100 people carry MRSA on their bodies, with no symptoms of infection.

A MRSA infection may at first be mistaken for a spider bite.  It may appear as a bump or infected area on the skin and could be accompanied by a fever.  The CDC website provides photos of MRSA skin infections to help the public identify this potentially serious infection.

Older people and those with compromised immune systems are most vulnerable to MRSA infection.  For that reason, healthcare facilities are the most common environment of MRSA transmission.  In otherwise healthy people, however, MRSA infections are usually mild and improve after a few days of oral antibiotic treatment if the infection is sensitive to the antibiotic.  Those infections are called “community-associated MRSA,” and are common in environments in which healthy people interact in close quarters; your gym is just such an environment.

Within the gym, intentional skin-to-skin contact (e.g., during wrestling and martial arts training) and unintentional skin contact between teammates during practice and competition (e. g., volleyball) are documented risk factors for MRSA transmission, according to a 2008 review of MRSA infection in athletes1.  Skin damage during exercise, e.g., mat burns, broken blisters, and other workout related injuries that abrade the skin, represent another common risk factor, particularly if broken skin contacts MRSA-contaminated surfaces.

Tips for avoiding MRSA infections at the gym:

  • WASH YOUR HANDS – thoroughly with soap and water before and after your workout and after using the bathroom; bar soap should not be shared during MRSA outbreaks; use liquid soap instead
  • SHOWER – promptly after any skin-to-skin contact; use liquid soap
  • OTHER PEOPLE’S OPEN WOUNDS – don’t touch wounds or bandages
  • YOUR OWN OPEN WOUNDS –
    • Cover and protect with clean bandages
    • Avoid using whirlpools, therapy pools and swimming pools
  • DISINFECT EQUIPMENT – wipe down exercise equipment (e.g., wrestling mats and the bench press), before and after use, with disinfecting wipes; use bleach wipes or other EPA-registered products that are effective against MRSA.
  • DON’T SHARE –
    • Razors with others; according to the 2008 review of MRSA transmission in the gym, razors create tiny lacerations, which increase the risk of acquiring MRSA from others
    • Towels with others; if shared towels have not been laundered between uses, they may be contaminated with MRSA
  • AVOID REUSING UNLAUNDERED EXERCISE CLOTHES – use fresh, clean clothes for each workout
  • LAUNDER – sweaty gym clothes and towels promptly after your workout; if laundering instructions permit, use chlorine bleach

A final tip:  Keep up the good work at the gym.  In the grand scheme of things, the benefits of working out greatly overshadow the risk of MRSA infection.  Why not increase your benefits by following these tips?

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

Bruce Bernard, PhD, is President of SRA Consulting, Inc., and Associate Editor of the International Journal of Toxicology, and lives in Cambridge, MD.

Click here to download this article.


1 Cohen, P.R. (2008).  “The skin in the gym:  a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes,” Clinics in Dermatology, 26, 16-26.

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Understanding Norovirus in Less than Three Minutes
Written by Barbara M. Soule, RN, MPA, CIC, FSHEA

Norovirus:  It’s the leading cause of outbreaks of diarrhea and vomiting in the US.  The virus can spread like wildfire through homes, schools, healthcare facilities, sports teams, child care centers and nursing homes.  Norovirus causes an average of 20 million cases of illness each year, including tens of thousands of hospitalizations and hundreds of deaths, mostly among young children and the elderly.  The winter months are usually the busiest season for norovirus.

There is no vaccine to prevent norovirus, but understanding how it spreads can go a long way to avoiding it.  The CDC animated video above presents the facts about norovirus in a clever, simple-to-understand way.  My hope is that this video will go as “viral” as norovirus itself.  Share it widely, and be well.

For more information on norovirus, please see this CDC webpage.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council.

Click here to download this article.

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Preventing RSV
Written by Ralph Morris, MD, MPH

What is RSV?
RSV is “Respiratory Syncytial (sin-SISH-uhl) Virus,” a virus that affects the lungs and breathing passages.  In healthy people, an RSV infection resembles a cold (colds are caused by rhinoviruses, another type of virus), but the very young and the very old[1]
and those with weakened immune systems may develop more serious symptoms.  Healthcare and child care workers are also at risk for RSV infections.

RSV affects millions of children each year.  According to the U.S. Centers for Disease Control and Prevention (CDC), RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (lung infection) in children younger than one year of age in the United States.  CDC notes that nearly all children will have an RSV infection by their second birthday.

Up to 40 percent of children will have signs or symptoms of bronchiolitis or pneumonia after their first exposure to RSV, and a small percentage of children will require hospitalization.

When should I go to the doctor?

Bronchiolitis and Asthma?
According to KidsHealth, children who have had bronchiolitis may be more likely to develop asthma later in life, but more research is needed to understand what, if any, relationship exists between bronchiolitis and asthma.

When symptoms become severe, it’s time to go to the doctor.RSV symptoms resemble other respiratory infection symptoms, including a runny nose and decreased appetite beginning about four to six days after exposure to the virus.  Coughing,
sneezing and fever commonly develop one to three days later.
Wheezing may also develop. In very young infants, the only symptoms may be irritability, decreased activity, and breathing difficulty.
Healthcare providers can assess the severity of RSV infection and determine if the patient requires hospitalization.   Severe cases of infection may require supplemental oxygen, suctioning mucus from the airways or using a breathing tube. Some patients may be treated effectively with hyperbaric oxygen[2].

How can I prevent RSV?

There is no vaccine to prevent RSV, and antibiotics are not effective unless a secondary bacterial infection occurs.  People can be infected with RSV more than once, but symptoms may be milder in subsequent infections. The CDC poster at the beginning of this article outlines six strategies to help prevent RSV infection.

RSV is spread by direct or close contact with contaminated secretions, such as mucous.  Keeping sick children home from day care is key to preventing the spread of contagious illnesses like RSV.  Keep in mind that very young children and children with weakened immune systems can continue to spread the virus for one to four weeks.

The virus is easily transported from the hands, where researchers say it can live for over 30 minutes, to the eyes and nose.  It also survives on surfaces for several hours.[3]  That’s why CDC recommends frequent hand washing, covering coughs and sneezes, and keeping hands away from the face.

Disinfecting Surfaces Contaminated with RSV
According to researchers, RSV can be destroyed on  frequently touched hard surfaces by first cleaning with detergent and water and then applying a one-to-ten dilution of regular (5.25%) bleach and water (e.g., one cup of bleach to nine cups of water).4 

For more information about RSV, please see http://www.cdc.gov/rsv/index.html.


Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

Click here to download this article.


1 Falsey AR and Walsh EE (2005).  Respiratory Syncytial Virus infection in elderly adults.  Drugs Aging, 22(7) 577-87 (Abstract).

2 Hyperbaric oxygen treatment refers to administering oxygen at a higher level than atmospheric pressure.

3 Eiland, L.S. (2009).  Respiratory Syncytial Virus:  Diagnosis, Treatment and Prevention, J Pediatr Pharmacol Ther. 2009 Apr-Jun; 14(2): 75–85, (online:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461981/)

4 If using 8.25% bleach, make a one-to-16 dilution (e.g., one cup of bleach to approximately 16 cups of water).

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Closing Produce Contaminant Loopholes
Written by Water Quality & Health Council

What role could organic and locally sourced produce have played in the recent Chipotle foodborne illness outbreaks?  As we reported previously, Chipotle’s 2014 annual report notes the company’s “significant commitment to serving local or organic produce when seasonally available.”  Chipotle admits these initiatives may “present additional risk of food-borne illnesses given the greater number of suppliers involved in such a system and the difficulty of imposing our quality assurance programs on all such suppliers.”  We agree, and we suggest that uncertainties and “contaminant loopholes” exist in federal regulations that may be contributing to US foodborne outbreaks associated, not only with Chipotle, but with any vendor or consumer sourcing local and organic produce.

Guidance to Minimize Produce Contamination

What is Organic?
A product labeled “organic” must be certified by the US Department of Agriculture (USDA), and be produced and processed according to USDA standards.  The USDA website indicates, “Overall, organic operations must demonstrate that they are protecting natural resources, conserving biodiversity, and using only approved substances.”Organic standards address soil and water quality, pest control, livestock practices, and rules for food additives.  Organic practices avoid the use of synthetic fertilizers, sewage sludge, irradiation and genetic engineering and most pesticides, according to the USDA Organic Practices Factsheet

Improperly composted manure and improperly applied raw manure fertilizers are major sources of pre-harvest microbial contamination. Contaminated irrigation water is another potential source of pathogens.  According to the Food and Drug Administration (FDA), organic farmers in particular utilize raw manure, which is seen as an effective source of nitrogen and other soil nutrients, especially when multiple crops are produced in the same field in one growing season.

Government guidance to minimize microbial contaminants in fruits and vegetables notes that good agricultural practices regarding animal manure fertilizers includes treating (e.g., composting) manure to reduce pathogens and maximizing the time between applying manure to cropland and harvesting crops.  Proper composting procedures are well documented and microbial standards set limits on detectable amounts of bacteria following treatment.  From a microbial safety perspective, appropriately developed compost is preferable as a fertilizer to raw manure, but when raw manure is used, what is the appropriate time interval between applying manure and harvesting crops?  According to FDA, as part of its new Produce Safety Rule, the agency is conducting a risk assessment and extensive research over the next five years to answer that question.  FDA notes for the time being, it does not object to farmers adhering to the US Department of Agriculture’s (USDA’s) National Organic Program (NOP) standards, which require uncomposted animal manures be applied …at least 90 days prior to harvest for crops whose edible portions do not come in contact with the soil and at least 120 days prior to harvest of crops whose edible portions do come in contact with the soil…”

Loopholes for Contaminants

Buying local or organic produce? Here are some relevant questions for your seller:

  • Was animal manure used for fertilizer?
  • When was the manure applied relative to harvesting?
  • If purchased at a farmers’ market, how was produce protected against contamination after harvesting?

As important as the planned FDA research and risk assessment are, some of the farms selling produce to vendors may be unaffected by the resulting recommendations. That’s because the new FDA rule does not apply to farms that have an average annual value of produce sold during the previous three-year period of $25,000 or less.  Qualified exemptions are also possible for farmers whose food sales average less than $500,000 per year during the previous three year period and sell predominantly to either the consumer of the food or a local restaurant or retail food establishment.  This may constitute a loophole for small farms that do not adhere to best organic practices.  Of course, large organic farming operations can also inject risk into the food supply by not abiding by science-based organic practices.

Many restaurants also sources produce from farmers markets.  A 2014 study1 of microbial safety and quality of fresh herbs from 13 farmers’ markets in California and Washington concluded a relatively high level of microbiological contamination of fresh herbs compared with that reported in previous studies.  How prevalent is this problem? The authors note more research is needed, but that “storing herbs at ambient temperatures in the open environment during warm summer days could impact the microbiological safety and quality of these items.”  Could this be another contaminant loophole for vegetable ingredients?

Safety comes first, and Chipotle is being proactive in the face of the recent outbreaks to close contaminant loopholes.  In a December 18 MarketWatch article, Chipotle communications director Chris Arnold is quoted as saying the chain is “implementing new programs that will make us an industry leader in food safety.”  These include cutting down on local ingredients and moving toward more centralized vegetable preparation.  Where smaller suppliers are still involved, however, we recommend Chipotle and other vendors require adherence to the same food safety standards to which larger suppliers are held.  That would be a win-win for both the small farmer and the companies that have made a strong safety commitment to their customers.

Click here to download this article.

1 Levy et al. (2014).  Microbial safety and quality of fresh herbs from Los Angeles, Orange County and Seattle farmers’ markets, Journal of the Science of Food and Agriculture, 95:  2641-2645 (abstract)

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When Fresh Ingredients Make Consumers Sick
Written by Water Quality & Health Council

Over 140 Boston College students were sickened recently after eating at a Chipotle restaurant near the Chestnut Hill, Massachusetts campus.  The culprit:  norovirus, the most common cause of foodborne illness in the US.  The norovirus outbreak comes on the heels of a multistate outbreak of E. coli associated with Chipotle that made 52 people sick in the Pacific Northwest.

In response to these outbreaks, Chipotle has been in frequent communication with the media, including a pointed interview with Chipotle’s founder, Steve Ells.  Additionally, according to the Chipotle website, the company is taking several steps to ensure “best-in-class food safety.” These steps include voluntarily closing restaurants, conducting deep cleaning and sanitization of restaurants in the affected area, testing surfaces, equipment and food, and enhancing internal training.  These are all steps in the right direction.

The Public Health Perspective

Chipotle prides itself on using fresh produce and meats, traditional cooking methods and local and organic produce, when seasonally available, factors that the company admits in its 2014 annual report, may present additional foodborne illness risk:

“…we have made a significant commitment to serving local or organic produce when seasonally available, and a small portion of our restaurants also serves produce purchased from farmers markets seasonally as well. These produce initiatives may make it more difficult to keep quality consistent, and present additional risk of food-borne illnesses given the greater number of suppliers involved in such a system and the difficulty of imposing our quality assurance programs on all such suppliers.”

The statement above is telling and honestly assigns a degree of risk to what many perceive as an unquestionable health advantage:  produce that is local, organic, seasonally available and sourced from farmers’ markets.

Folks will look at this in one of two ways:

  1. For some, the increased risk of foodborne illness is acceptable to avoid produce harvested using traditional agricultural practices, including manufactured fertilizers and pesticides.
  2. Others may be wary of the trend for restaurant chains to increase their use of organic produce without increased steps by suppliers and restaurants to prevent food contamination.

Chipotle should be congratulated for their honesty in acknowledging their food safety problems, and the company should continue to share its findings and plans to tackle those problems.  For their part, consumers must make their own choices about where and what to eat based on their own health perspective.  As with all decisions we make regarding acceptable or unacceptable risks, the accuracy of the decision depends upon the use of accurate and reliable information.

Click here to download this article.

In the coming weeks:  “What is Organic Produce?”

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Five Flu Facts


CDC director, Dr. Tom Frieden gets this year’s flu vaccine. Photo from www.cdc.gov/flu/professionals
  1. Getting the flu vaccine is strategic. Getting the annual flu vaccine is the single best thing you can do to prevent the flu.  The US Centers for Disease Control and Prevention (CDC) recommends a yearly flu shot for everyone six months old and older.  Some folks are proudly posting their “vax” photos on the CDC’s website!  Follow on Twitter at #VaxWithMe.
  1. Flu can be complicated. Although most people who get the flu will have a mild illness, flu complications can include pneumonia, bronchitis, sinus or ear infections and even death.  Those at high risk for flu-related complications include pregnant women; children younger than five, but especially children younger than two; people 65 years old and older; and people of any age with certain chronic medical conditions such as asthma, diabetes and heart disease.

Unsure as to whether you have the flu or the common cold?  This chart can help you decide.

  1. Timing is everything. According to CDC, flu activity usually peaks in January or later, but outbreaks can happen as early as October.  It takes about two weeks after being vaccinated for the body’s immune response to kick in fully. 

Planning holiday visits?  Take a look at the calendar and schedule your flu shot to make sure you arrive for holiday gatherings as fully protected as possible. 

For Frequently Touched Surfaces:

Clean surfaces first with detergent and water and then sanitize using 1 tablespoon of regular strength household bleach (5.25%) in 1 gallon of water.  If using concentrated bleach (8.25%), reduce bleach volume to 2 teaspoons per gallon of water. Let surfaces air dry.

  1. Prevention is key. The flu virus wants you!  Evade it by:
  • Avoiding close contact with people who are sick
  • Staying home when you are sick
  • Covering your coughs and sneezes with a tissue, or cough into your sleeve
  • Washing your hands frequently with warm water and soap for at least 20 seconds
  • Keeping your hands away from your eyes, nose and mouth
  • Cleaning and disinfecting frequently touched surfaces in your environment
  • Getting sufficient exercise, hydration, nutrition and rest
  1. A flu pandemic (a world-wide flu epidemic) would be another story altogether. Flu severity is unpredictable from year to year.  While it’s not expected this year, a flu pandemic is always a possibility.  To keep tabs on the flu, CDC provides a weekly flu surveillance report.  The website includes a handy “Flu Activity Map” to indicate the geographic spread of flu through the US.

To get an idea of how you could prepare for a pandemic flu outbreak, check out Dr. Ralph’s Flu Preparedness Closet.  Forewarned is forearmed!

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN

Click here to download this article.

TESTING

This Holiday Season, Don’t be a Germ Re-gifter
Written by Water Quality & Health Council

As you gather with family and friends to mark the holidays, beware the coughing, sneezing person who should have stayed home.  This person is a re-gifter, not of an unappetizing fruit cake, but of germs that can hardly wait to make you sick.


View/download full coloring page

Germs survive by re-gifting, propelled by guest “A” through the air in an uncovered cough to be inhaled by guest “B” in her next breath.  Now “B” is infected and soon will be culturing her own army of germs to be re-gifted by coughing and sneezing.

The downloadable poster at left, based on messages from the US Centers for Disease Control and Prevention, offers practical tips for curtailing the spread of germs to others.  It reminds everyone to cover their cough or sneeze with a tissue or by blocking the cough with their sleeve.

These responses to coughing and sneezing are preferable to using hands to cover a cough.  After all, it is our hands that reach into the bowl of chips and touch all the serving spoons in the buffet line.

Disinfecting frequently touched surfaces such as door knobs and hand rails with a simple chlorine solution goes a long way to blocking the spread of germs from surfaces to hands.  And speaking of hands, don’t miss the hand-washing tip on the poster:  It’s still the single most important strategy we have for preventing the spread of germs.

Healthy habits are best instilled at a young age.  Help raise a new generation of children who act to prevent germ re-gifting! Download the poster to give to the children in your life for coloring.

How to Mix a Flu Germ-Busting Solution

1 gallon of water

1 tablespoon of regular strength bleach or 2 teaspoons of high strength bleach

  1. Clean surface with detergent and water.
  2. Sanitize using the bleach solution.
  3. Let air dry.

 

Healthy Holidays to You and Yours!

Click here to download this article.

 

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Trendy or Traditional, Safe Food Preparation is a Must this Thanksgiving
Written by Linda Golodner

As I prepare to host Thanksgiving once again, I think about how the holiday has changed over the years.  Traditionally the day is marked by a scrumptious feast with a turkey in the spotlight.  Increasingly, in many households, there is greater focus on vegetable and grain dishes to please those who prefer a healthier cuisine and for the vegetarians around the table.  Creative holiday recipes abound on TV food channels and the Internet!

Whether your holiday menu will include turkey or tofu, be trendy or traditional, or contain elements of all of these, safe food preparation is a must.  And remember, food safety is not just about meat, poultry and seafood.  A 2013 study by the US Centers for Disease Control and Prevention concluded that between 1998 and 2008, vegetables accounted for the single greatest percentage of foodborne illnesses, although meat and poultry were responsible for the greatest percentage of deaths.

Help keep Thanksgiving healthy and happy by following the food safety tips below.

Avoiding Foodborne Illness this Thanksgiving

Clean – wash all food contact surfaces with hot, soapy water followed by sanitizing with 1 tablespoon regular strength or 2 teaspoons of high strength chlorine bleach in 1 gallon of water. Do this before and after working with raw foods. And don’t forget to wash all fruits and vegetables with tap water, even the pretty grapes you might use for decoration. Cooking destroys many pathogens, but we eat many uncooked fruits and veggies in salads, for example.

Separate – keep fresh fruits and vegetables separate from raw meat, poultry and seafood.

Cook – to kill any bacteria that might be present, thoroughly cook meat, poultry and eggs to the appropriate temperature.

Chill – refrigerate leftover perishables at 40 degrees Fahrenheit within 2 hours of cooking or serving. This safety tip is a difficult one to remember at Thanksgiving. It is often a time to linger over food with family, but tear yourself away from the table and put those leftovers in the refrigerator within 2 hours.

 

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.

Click here to download this article.

 

TESTING

Healthy Visits to Patients in Healthcare Facilities
Written by Barbara M. Soule, R.N. MPA, CIC, FSHEA

Much of human life begins and ends in healthcare facilities.  These institutions are also places of treatment, healing and recovery.  It is natural, therefore, that visitors to patients in healthcare facilities can be so focused on the emotional aspects of connecting with their friends and loved ones that they forget to take precautions to avoid spreading infection.
The following tips are meant to promote healthy visits to patients in healthcare facilities.

Infection Prevention Starts with Your Hands 

According to the US Centers for Disease Control and Prevention (CDC), hand washing is the single most important means of preventing infections.  Wash your hands as you enter the patient’s room, frequently while in the room, before and after touching the patient or the patient’s immediate environment, and just before leaving the room.  Use hand sanitizer stations if warm water and soap are unavailable.  It is perfectly acceptable to remind family, friends and healthcare providers, including doctors, nurses, certified nursing assistants and physical therapists, to wash their hands upon entering a patient’s room.  The CDC provides detailed directions for proper hand washing.

The Heywood Hospital website also notes that your skin is an important barrier to infection, so use moisturizers, especially in winter, to prevent cracking.  Keep all cuts and scrapes clean and covered with a bandage.  Never touch patient wounds or catheters (tubes) unless instructed by the staff.

Stay Home if You’re Sick

Don’t visit a healthcare setting if you have a cough, cold, fever or diarrhea.  A phone call, text, email or written note can communicate your good wishes without the risk of spreading unwanted germs.  The MedlinePlus website also recommends you stay home if you were exposed to chickenpox, the flu or any other infections.

Stay up to Date with Your Immunizations

The seasonal flu vaccine is recommended for everyone six months old and older.  The flu shot is especially important for people who are at high risk for serious complications from the flu, including children younger than two, adults 65 years of age and older, pregnant women, residents of nursing homes and other long-term care facilities and people with weakened immune systems. Your doctor can advise you about obtaining other vaccines, such as a pneumonia vaccine.

Observe Good Visitor Hygiene

Don’t sit on the patient’s bed or put your feet on the bed.  Don’t share the patient’s food or drinks.  Use toilets meant for visitors, and not the patient’s toilet. Don’t bring food, toys or special pillows, blankets or pets into the patient’s room unless approved in advance by the staff.

The MedlinePlus website urges visitors to keep their hands away from their faces and to cough and sneeze into a tissue or the crease of the elbow.  Avoid coughing or sneezing into the air.  Wash your hands after tending to a cough or a sneeze.

Don’t Contribute to Hospital Room Clutter

The Association for Professionals in Infection Control and Epidemiology website recommends you think twice about cluttering up the patient’s room with personal items.  Clutter makes cleaning more difficult, and cleaning and sanitizing surfaces are a critical part of healthcare.  The association notes patient items should be kept off the floor and away from waste containers. The bedside table and over the bed table also should be kept clear of unnecessary items that interfere with environmental cleaning.  In fact, a recent Wall Street Journal article on reducing hospital infections quotes this advice from a founder of a patient advocacy and education group:  “forget flowers and candy; bring bleach wipes instead,” she says. “It could save their life.”

Visiting friends and family in healthcare facilities can be an emotional experience, but keep in mind that your actions in the healthcare setting can affect the health of the patient you visit.  Tuck these hints away for the next time you call on someone in a healthcare setting to help ensure your visit is a healthy one.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council.

Click here to download this article.

 

TESTING

A Fun Way to Teach Kids about Hand-washing
Written by Water Quality & Health Council

How can you help your children avoid some of the infectious illnesses that will be shared this season? According to the US Centers for Disease Control and Prevention, proper hand-washing is one of the most important ways to avoid getting sick and spreading germs to others. But nagging kids to wash their hands is seldom effective.

We suggest delivering the hand-washing messages in a fun way using the activity sheets below. The following sheets were developed by the University of Nebraska, Lincoln Extension and the Lincoln-Lancaster County Health Department. Unlike this year’s flu, cold and norovirus, we hope these sheets “go viral,” helping your children develop a life-long healthy hand-washing habit!

Click here to download this article.

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